Delta variant cases overwhelm contact tracing in hard-hit states

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Nationwide health departments cut back on their contact tracing in late spring or early summer when Covid-19 cases began to decline as vaccination efforts took center stage .

Then delta hit.

Now state and local health departments are trying to rebuild operations with depleted resources as Covid fatigue among their workers and the public complicates these efforts.

“Contact tracing since the start of this pandemic has given us some really valuable information,” said Dr Amanda Castel, professor of epidemiology at George Washington University. Castel said it was still “a fundamental part of our response”.

As are Covid tests, especially for vulnerable or unvaccinated people, such as children under 12. Yet many departments now find themselves with fewer contact tracers and less robust programs. Like the tests, contact tracing appears to have been abandoned.

Contact tracing is a resource-intensive operation, requiring workers to promptly call people who test positive for a disease and offer them medical advice, then identify and contact anyone with whom those infected have been in close contact. . The hope during the pandemic is to prevent the spread of the coronavirus and to observe its progress. Public health officials have used the process for decades to stop the transmission of the disease.

But many public health services have been overwhelmed by the Covid attacks. Last winter – before vaccines provided relief – they weren’t able to stay ahead of the virus through contact tracing. And as the number of cases declined due to increased immunization rates in the spring and early summer, more than a dozen state health departments downsized, researcher Crystal Watson said. principal and assistant professor at the Johns Hopkins Center for Health Security. Resources were needed for immunization initiatives and to restart other public health programs.

The situation has turned critical in a number of states over the past month or so, as local health officials once again find themselves behind as the delta variant increases the number of cases. Resources are already depleted, and the politicization of Covid has left local officials making hard calls as to who to look for in places like Missouri and Texas. And some states just don’t have enough staff to do the job. The army of disease detectives most often included temporary staff or officials from outside the health services. In Kentucky, the former director of contact tracing is now the commissioner of the aviation department. The state’s public health department said it had a successor, but declined to name who.

The highly contagious delta variant makes the job more difficult. Cases can pile up quickly. Public health services, which are chronically understaffed and underfunded, must choose the tools that will be most useful to them.

“There are places that have done a good job of keeping some sort of reserve workforce that they could call back. And I’m sure it’s getting useful right now. Other places have not. And they’re probably going to be quickly overwhelmed, ”Watson said. “It’s also hard to say because there isn’t a lot of public reporting. “

Arkansas, where Republican Gov. Asa Hutchinson now says it was a mistake to have signed a law in April banning mask warrants, is averaging around 2,000 new cases a day, one of the biggest increases important among states. But the state’s health department now has far fewer contact tracers – 192, up from 840 in December, when the number of cases was at the same level, according to the department and data collected by Johns Hopkins.

Arkansas Department of Health spokesperson Danyelle McNeill said contractors doing the work were allowed to increase the size of their staff. She also said the agency was triage of cases, prioritizing those who tested positive or diagnosed with Covid within six days of sample collection or onset of symptoms, which the Centers for Disease Control and Prevention recommended when capacity is limited. She said sellers don’t call all positive cases the same day they received listings when infections neared 2,000.

You have an audience that is really not in favor of contact tracing and quarantine.

In states that have chosen to minimize contact tracing, county and city health officials are on their own. In the hard-hit southwestern Missouri region, the flood of cases overwhelmed already stretched staff, said Katie Towns, director of the Springfield-Greene County Department of Health, so the department has pivoted to conduct contact tracing only in cases involving children under 12 years of age. , who do not have access to vaccines, Towns said.

Lisa Cox, spokesperson for the Department of Health and Seniors’ Services, said “local health departments will work to triage and prioritize case investigations and will work with them if assistance is needed.” His department is awaiting financial support through the US federal bailout, but funds have not yet been allocated. Ultimately, local strategies will come down to priorities. “We have made it clear that local courts must make decisions locally based on their unique circumstances.”

The peak capacity of the Springfield-Greene County Health Department declined as team members were redeployed to other health programs, which had been neglected during the pandemic. But Towns said that even with unlimited resources, she wonders how effective investing anything in contact tracing would be: Covid is rampant and compliance with public health measures has declined. It would be more likely to deploy more people for outreach and immunization distribution.

Kelley Vollmar, executive director of the Jefferson County Department of Health in eastern Missouri, said the delta’s surge hits a community polarized against public health efforts. “You have an audience that is really not in favor of contact tracing and quarantine, and the funding for contact tracing and infrastructure is not there like last year,” a- she declared.

Controversy over contact tracing

The Texas Department of State Health Services “is ending its contact tracing program to meet budget requirements.” In the new budget, which goes into effect on September 1, health services are expressly prohibited from using taxpayer money for Covid contact tracing.

“We will continue to conduct case investigations and other public health follow-ups,” Chris Van Deusen, director of media relations at the state health department, said by email, “but will not provide contact tracing for local health services “.

The Texas Education Agency, which oversees elementary and secondary education, also said this month that schools are not required to trace contacts.

Contact tracing has been clouded by controversy in Texas. Five lawmakers sued Republican Gov. Greg Abbott and the Department of Health last August for awarding a contract to run the program.

“The policy of finding contracts was never established as a policy accepted or supported by the Texas legislature,” the lawsuit said. Another lawsuit filed the same month by dozens of Texans alleges the adoption of contact tracing violates their constitutional right to privacy.

In Williamson and Bexar counties in Texas, where community transmission of Covid is high, local health officials are troubled by the lack of statewide tracing.

Williamson County turned to the state’s health department for help with contact tracing and case investigation as 50 to 100 new cases per day were being reported.

The county health department, which is separate from the county government, has also trained more than half of its staff in contact tracing, from clinical staff to media officials, epidemiologist Allison Stewart said. Chief of the Williamson County and Towns Health District, but all 65 people, including outside staff and volunteers, were unable to track cases. Some worked seven days a week or 12 hours a day, but now the county is dependent on the state for work.

“We can’t go back to that time now because all of the people we used are actually doing their real jobs,” she said. “We’re trying to figure out what the plan is for September 1 right now. And that may mean that the plan is that we don’t do case investigation or contact tracing.

“Honestly, we don’t know,” she said.

San Antonio, in Bexar County, one of the largest cities in the country, has its own contact tracers, but it relies on the state whenever there is an increase, said Rita Espinoza, chief of epidemiology of the city. San Antonio relies on the state and is therefore able to handle the load without arrears, Espinoza said. She is worried about what will happen in the fall, after the start of the school year, and that there are more possibilities for transmission. The staff is already operating with a reduced capacity of 80 people.

“The specific impacts are unknown, but it may impact efforts to improve other infectious disease investigations,” Espinoza said.

Florida, where Covid has become a political buzzword, is another state where the tension is playing out. Broward County Mayor Steve Geller said he had asked about contact tracing capabilities, including the number of investigators the state health department has, but he said that he had only been told: “We are working on it.” It’s under control. Contact tracing data is not publicly available; Republican Gov. Ron DeSantis once told local reporters that the contact tracing “just didn’t work”.

Geller did not push health officials for information given that “contact tracing doesn’t work well when everyone has Covid” and Covid data has become controversial in Florida.

“I am not trying to create new martyrs,” he said.

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